This proposal outlines a strategy for weaning children from mechanical ventilation, using a computerized protocol. This proposal has two major goals: 1) Integration of a computerized decision support tool that accesses existing database servers at Primary Children's Medical Center. 2) Evaluation of the feasibility and utility of a computerized protocol to assist with weaning children with acute respiratory failure from mechanical ventilation. In the first specific aim, a consensus panel of pediatric critical care practitioners will develop a weaning algorithm that is simple and reasonable. The protocols and incorporated logic will be examined, at the bedside, using paper-flow diagrams for applicability in weaning children from mechanical ventilation. These protocols will then be programmed using network technology to access existing database servers. Practitioners involved in weaning children, with acute respiratory failure, from mechanical ventilation will then evaluate the validity of the protocols. In the second specific aim, children will be entered into a prospective, randomized, controlled clinical trial to evaluate the utility of a computerized protocol to wean critically ill children from mechanical ventilation. Children with acute respiratory failure requiring mechanical ventilation will be entered into either a computerized protocol driven weaning strategy arm or the "standard" physician driven weaning arm. These studies will yield information regarding the feasibility of using computerized protocols in pediatric critical care and potentially allow for the development of advanced protocols to assist physicians in managing critically ill children in a more efficient manner.